Retrospective Evaluation of Intussusception in Under-Five Children in Nigeria

Background: Assessment of the safety profile of the new rotavirus vaccines in Africa requires base-line epidemiological data on intussusception. Hence, this study was aimed at describing the prevalence and associated factors of intussusception in under-five children in Enugu, Southeast, Nigeria. Methods: This was a retrospective descriptive study involving the sixty reported cases of intussusception in under-five children admitted in a hospital in Enugu between 2007 and 2012. Cases of intussusception were selected using the Brighton collaboration intussusception working group level I diagnostic criteria. Information sought from the patients’ folders included demographic characteristics and clinical manifestations including history of previous rotavirus vaccination, duration of illness prior to presentation, diarrhoea, vomiting, passage of red currant jelly-like stool, abdominal mass and distension, method of diagnosis, treatment option(s) employed and their outcomes. The data was analyzed using SPSS version 17.0. Results: The majority of the cases were aged less than one year (53;88.3%) while the average incidence of intussusception was 0.1 per 1000. None of the cases had received rotavirus vaccinations. The common clinical presentations were vomiting, 55 (17.2%), passage of red currant stool 50 (15.6%), fever 50 (15.6%) and abnormal/absent bowel sound 43 (15.9%). Diagnosis was essentially with the aid of abdominal ultrasonography, 38 (63.3%) while surgery (laparotomy) was the treatment of choice in most cases 48 (80.0%). The case fatality rate was 3 (5.0%). Conclusion: None of the cases studied could be directly linked to rotavirus vaccinations. But seasonal peak incidence coincided with rotavirus diarrhea peak incidence. Efforts should be made to institute post-rotavirus vaccine licensure prospective surveillance study in order to fully determine any relationship between rotavirus vaccination and intussusception in Enugu, South east, Nigeria.

Erratum to “Retrospective Evaluation of Intussusception in Under-Five Children in Nigeria” [World Journal of Vaccines Vol.4 No.3 (August 2014) 123-132]

The original online version of this article (Tagbo, B. N., et al. 2014 “Retrospective Evaluation of Intussusception in Under-Five Children in Nigeria”, 2014, 4, 123-132, http://dx.doi.org/10.4236/wjv.2014.43015) was published in August 2014. The author wishes to correct the author’s name and the Table 3 in the text.

Vaccination Coverage and Its Determinants in Children Aged 11 - 23 Months in an Urban District of Nigeria

Background/Objectives: Performance of the vaccination programme in Nigeria is lower than the regional average as well the 95% target necessary for sustained control of vaccine preventable diseases. This study is aimed at assessing the vaccination coverage and its associated factors in children aged 11 - 23 months in Enugu Metropolis. Methods: A cross sectional study in which caregivers and their children pair, aged 11 - 23 months attending children’s outpatient clinics in Enugu metropolis was undertaken. Respondents were selected consecutively while data were collected using pretested interviewer administered semi-structured questionnaire. Data were analyzed using SPSS version 20.0 while level of significance was set at p < 0.05. Logistic regression analysis was used to identify independent predictors of full vaccination. Results: Of 351 subjects studied, 84.9% (298) were fully immunized according to the national programme on immunization schedule using both vaccination cards and history. The OPV0, OPV3, pentavalent-1, pentavalent-3 and measles coverage at the time of survey were 100.0%, 97.2%, 98.0%, 98.6%, 96.9% and 95.4%, respectively. On logistic regression: maternal occupation (government employees), children born in government hospitals and knowledge of when to start and complete vaccinations in a child were the likely predictors for completion of full vaccination in the children. Conclusion: The vaccination coverage among the study group was adjudged to be relatively high. Delivery of a child in a government hospital and the knowledge of the age when routine vaccinations should begin and end in a child were the independent predictors of the high vaccination coverage rate observed. Awareness and health education efforts in government tertiary hospitals should be extended to private and other hospitals to improve and sustain national vaccination coverage in Nigeria.

Predictors of Exclusive Breastfeeding Duration among Mothers Attending Immunization Clinic in a Tertiary Health Facility in Enugu, Nigeria

Background: Breastfeeding is cost effective means towards the realization of some key United Nations Sustainable Development Goals by the year 2030 particularly in resource limited settings. The objectives of the study were to evaluate the predictors of exclusive breastfeeding duration among mother and child pairs utilizing a tertiary immunization clinic facility. Methods: This was a cross-sectional descriptive study. Respondents were mother-and-child pairs who were recruited consecutively. Relevant maternal and child characteristics were collected using a semi-structured questionnaire. Data were analyzed using Statistical Package for Social Sciences version 20.0 (p Results: Four hundred and twenty seven mother-child pairs were studied. Majority of the mothers have at least secondary education, 383 (80.7%). 407 (95.3%) of the mothers fully understood the actual meaning of EBF. 189 (42.7%) reported practicing EBF in their index child for six months. Maternal perception of insufficient milk production, 52/99 (52.5%) was the most common reason for practicing EBF for Maternal education and occupation and gender of the child were significantly associated with completion of EBF for 6 months among respondents. Conclusion: EBF duration in the current study is low and is significantly associated with maternal education, maternal occupation and gender of the child. Improving girl child education, complementing baby friendly hospital initiative with baby friendly community initiative should be adopted to improve EBF duration in our setting.

Molecular Characterization of Rotavirus Strains Circulating in Enugu Nigeria: 2011 to 2016

Rotavirus gastroenteritis is a major public health concern globally, estimated to cause 215,000 deaths among children < 5 years of age in 2013;with majority of mortality occurring in developing countries. In 2013, it was estimated that Nigeria was the second country with the highest number of rotavirus deaths. Monitoring of circulating rotavirus strains in Enugu, Nigeria is part of on-going rotavirus surveillance before the introduction of rotavirus vaccination. A total of 2694 stool samples were collected from enrolled under 5 years old children with diarrhoea between January 2011 and December 2016 and tested the virus using an antigen enzyme immunoassay. Randomly selected rotavirus positive samples were further characterized by rotavirus genotype methods to identify the G and P types circulating during the study period. Rotavirus was detected in 1242 (46%) of the 2694 samples collected over the six years period. Of these, 867 were randomly selected for genotyping. G and P types could be assigned for 832 samples (96%), while 31 (3.6%) could only be assigned either genotype G or P (partially typed) and 4 (0.4%) could not be assigned genotype G and P (untypeable). The most common G-genotypes detected during the entire study period were G12, G1 and G3 accounting for 27.6%, 21.0% and 16.3% respectively. Mixed G and P-genotypes were commonly detected. Ninety-one of the samples, representing 10.8% (91/839) had mixed G-genotype whilst 130 of the samples representing 15.2% (130/852) had mixed P-genotype. The most common P-genotypes detected were P[8], P[6] and P[4] representing 38.3%, 35.4% and 9.1% respectively. The predominant strain detected was G12P[8] (22.3%) followed by G3P[6] (14.5%), G1P[8] (9.2%) and G1P[6] (8.0%). These data are useful for making an informed decision about the introduction of rotavirus vaccine into the national routine immunization program and to monitor the impact of the vaccine post licensure.

Introduction of Inactivated Polio Vaccine and Specific Determinants of Vaccine Hesitancy

Background: Introduction of inactivated polio vaccine is imminent and may encounter the challenges that face new vaccines especially vaccine hesitancy. The study evaluated factors that may contribute to hesitancy towards IPV. Methods: Questionnaire adapted from the model developed by the Strategic Advisory Group of Experts Working Group (SAGE WG) was used to assess the factors among 408 parents. The evaluation was under the 3 Cs: Confidence, Complacency and Convenience. Questions were scored on Likert 4-unit-scale system. The data were analyzed using SPSS and, multivariate analysis was used to further test individual significant variables. Results: Overall, Complacency (2.29) and Convenience (2.11) domains were more pro-vaccine hesitant, than Confidence (1.83) domain. However, none was significantly associated with likelihood of a parent’s hesitancy towards IPV vaccination. But certain individual questions: competence of vaccinators (p = 0.04), confidence that their child will not to be infected with poliomyelitis even when not vaccinated (p = 0.03) and, willingness to vaccinate with IPV when OPV is still in use (p = 0.01) were significantly associated with vaccine hesitancy. Conclusions: None of the factors can individually influence acceptance of IPV. However, competence of vaccinators, parental belief and availability of close alternative influenced parental decision to vaccinate.

Adenovirus and Rotavirus Associated Diarrhoea in under 5 Children from Enugu Rural Communities, South East Nigeria

Globally, diarrhoea is the second commonest infectious cause of death in children less than 5 years old. It is estimated that more than one billion diarrhoea episodes occur every year causing up to 700,000 deaths among children younger than 5 years of age. Seventy-two percent of these deaths occur in children below two years and enteric viruses have been recognized as a major cause of childhood diarrhoea. This study was undertaken to determine the prevalence of enteric Adenoviruses and Rotaviruses in children with diarrhoea in rural Enugu communities of Enugu State South East Nigeria. Methods: Stool samples were collected from children less than 5 years with diarrhoea seen in any of the participating hospitals in Enugu State. Samples were collected between June 2015 and May 2017. Detection of rotavirus and enteric adenovirus antigens were performed using commercially available ELISA kit (Oxoid-ProspecT&#174;). Demographic data of the children were also collected. Results: Of the 290 stool samples that had sufficient materials for adenovirus and rotavirus ELISA, 14 (4.8%) and 89 (30.7%) were positive for enteric adenovirus and rotavirus respectively. 3 (1%) were co-infected with adenovirus and rotavirus. Rotavirus positive cases were more among hospitalized patients while enteric adenovirus was more among outpatients. Marked peaks of rotavirus positivity were seen in January of each year but no peak was seen among adenovirus positive cases. Higher vomiting frequencies and severe dehydration were more among rotavirus positive cases compared to adenovirus positive cases (p = 0.030 and 0.001 respectively). Conclusion: Many diarrhoea cases among children aged <5 in the population studied were associated with enteric adenoviruses and rotavirus. This finding suggests that enteric viral agents (adenovirus and rotavirus) are important aetiologies for childhood diarrhoea in Enugu state Nigeria. Appropriate preventive, diagnostic and treatment interventions should be instituted so as to reduce the mortality and morbidity associated with these viruses.

Otitis Media in Children: Review Article

Otitis media is one of the most common infectious diseases of childhood. It is not uncommon for clinicians to miss the diagnosis of the acute form especially in younger children. Late and missed diagnoses result in poor management and increased risk of complications. This review highlights the epidemiology, presenting features, diagnosis, treatment and complications of otitis media.